Provider Demographics
NPI:1225394471
Name:FULCRUM ORTHOPAEDICS, PLLC
Entity Type:Organization
Organization Name:FULCRUM ORTHOPAEDICS, PLLC
Other - Org Name:ORTHOPAEDIC ELECTIVE SPECIALISTS, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-245-4424
Mailing Address - Street 1:7715 SAN JACINTO PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3215
Mailing Address - Country:US
Mailing Address - Phone:469-209-8099
Mailing Address - Fax:972-618-4444
Practice Address - Street 1:7715 SAN JACINTO PL
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3215
Practice Address - Country:US
Practice Address - Phone:469-209-8099
Practice Address - Fax:972-618-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122539OtherBLUE CROSS BLUE SHIELD
TX324751201Medicaid
TXTXB166573Medicare PIN